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Yeah its Friday!






Carly and I had a great day! All except one big crying jag when she woke up after her second nap. I think she's teething. She has a bunch of swollen mounds all through her gums on the sides and everything. She only has two top teeth and top bottom, so she'll probably get a bunch of teeth all at once. I think she's going to get the top left tooth beside the big one next. It feels ready. We had a fun day today. Tina and I are SO FREAKING in love with our kid. She is SUCH a dream. We started the day out with a walk with the dogs. Carly held Tina's hand and I took Roxy and Spence on leashes while Carly had to stop and smell every flower she passed. So cute!
Then, Carly and I went to pick up my ultrasound findings at my obgyn's. I have an appointment this Monday at 11:45 to see the breast surgeon and she wants to see it. Someone canceled, so they were able to move my appointment up. It was fun bringing Carly to see everyone. The last time they saw her she was only three months old. She's so grown up now!

My findings say: Diagnostic Category 4-Suspicious for Malignancy but findings does not exhibit classic findings of breast cancer: Round circumscribed homogeneous slightly hypoechoic 10 X 10 mm solid nodule corresponding to a palpable lump in the two o'clock position of the left breast, 6 cm radial to the nipple. Although this most likely represents a fibroadenoma, biopsy is recommended because the round shape of this lesion is not entirely classic for a fibroadenoma.
Recommedations; ultrasound-guided core biopsy:left breast.
So, what does Category 4 mean? Is it out of 1-10? Or is this a stage thing meaning stage 4, which is the highest number...hmmm. 10 x 10mm sounds pretty big too. It doesn't feel THAT big. Anyway, it will be good to have my appointment. The breast surgeon I'm seeing is a rock star. I saw her on Youtube.
Carly and I went to Surfbros for lunch and she absolutely LOVED it there. She couldn't stop looking at the artwork which was all over the walls of a big wave and a mermaid with a big flower. There were also two wooden parrots hanging from the ceiling that Carly kept pointing at and saying "OOOWWW!". It was adorable. She loved the food too..brown rice and teriyaki chicken kabobs with little bites of cabbage salad. She acted like such a big girl today. We really had fun together. Then we came home and I put her down for her second nap and she slept two hours. She's been getting up at 6am, which is early for us, so she's been definitely needing that second nap.
Then we went to the pool and had a TOTAL BLAST again. The water was so warm. Carly was playing on the steps and laughing at me so hard. It was hilarious. She went down for the ring three times and just floated slowly back up. Then I did this game where I was throwing her in the air and letting her fall into the water and she would float up for air super slow. She can hold her breath for such a long time now. Its amazing. She started crying when I tried to make her float on her back. She's gotten afraid of that, because I stopped practicing! DARN It! We'll get there again. She even held on the side of the pull a couple of times by herself. She did SO good. Then we played in the jacuzzi and did a photo shoot.
I'm going to go upstairs and hang out with my wife now and read 'My Life with My Sister Madonna.' I'm halfway through it. Its really good! I really enjoy reading, but few books keep my attention. So, I'm happy that I'm into this one. I would love some recommendations to some good books if anyone has them. :)

OH~ I just learned that their are 6 categories, which are:
Category 0: Assessment is incomplete

These examinations are incomplete until some further evaluation is performed. This can be in the form of additional mammographic views, comparison films, USG, or, less commonly, breast MRI. At times, in order to accurately assign a final BI-RADS classification, comparison with old films is required. The radiologist should use judgment on how vigorously to attempt to find old films for comparison and whether the report truly needs a category 0 coding vs category 1 or 2. Tracking old films can be time consuming and expensive and therefore 'category 0 (for comparison)' should only be used when such comparison is absolutely required for making a final assessment. Once comparisons or additional imaging studies are completed, a final assessment can then be rendered. Category 0 is often used in a screening situation.

Category 1: Negative

This is a completely negative exam with no significant findings. There are no masses, no architectural distortion, no suspicious calcifications, and no asymmetries.

Category 2: Benign

This is a normal assessment in which the radiologist describes a benign lesion that carries no malignant potential. Examples include cysts [Figure 2], lipomas, dystrophic calcifications [Figure 7], hamartomas [Figure 4], intramammary lymph nodes, implants, and many other benign findings of no clinical consequence.

Category 3: Probably benign

Category 3 remains a source of confusion and is sometimes controversial. This category is to be used in the presence of a finding that is almost certainly benign but for which a short follow-up is desired. It is never to be used as an indeterminate malignancy category or in lieu of a diagnostic work-up. In fact, this category has a <2% risk of malignancy and is unlikely to require biopsy. The finding is not expected to change quickly over time and therefore recommended follow-up involves a series of short-interval (6-month) follow-ups over a period of 24-36 months. After the finding has maintained a stable appearance for 2-3 years, it can be considered benign and be coded as a category 2 (benign) finding. In some instances, due to patient and/or clinician concern, some category 3 findings may end up being biopsied rather than followed. This category is not to be used when there is a palpable lesion. Examples of category 3 lesions include non-palpable, incidental, complicated cysts [Figure 13].

Category 4: Suspicious abnormality

This category includes findings that do not have a classic appearance for malignancy, but have a higher probability for malignancy than findings classified as category 3. Here, some form of intervention (preferably image-guided needle core biopsy) is recommended to establish a diagnosis. The wide range of outcome probabilities has stimulated a subdivision of category 4. An optional form of subdivision suggested by the ACR is 4A, 4B, and 4C. A 4A coding can be used for a finding with a low suspicion for malignancy but requiring some type of intervention. Examples include a palpable complicated cyst or probable abscess. Category 4B includes lesions with intermediate probability for malignancy. Such a lesion requires close radiologic and pathologic follow-up and is only truly benign if the results of both concur. Examples include fat necrosis and papilloma. Category 4C identifies findings that are of moderate concern but do not exhibit the classic signs of malignancy. A malignant result is expected in this category and it should alert pathologists and clinicians to carefully follow-up on these biopsies. Included here are ill-defined, irregular solid masses or new clusters of fine pleomorphic calcifications.

Category 5: Highly suggestive of malignancy

These lesions are almost certainly malignant, carrying a >95% probability of malignancy. Imaging findings exhibit the classic characteristics of malignancy and percutaneous tissue sampling may be required for oncologic management (i.e., neoadjuvant chemotherapy) or to plan a one-stage definitive surgical intervention that may include lymph node sampling. A spiculated, irregular, high-density mass would be a classic example of category 5 [Figure 3].

Category 6: Known biopsy-proven malignancy

This category is new and was added to accommodate breast findings that have been proven to be cancer by biopsy but for which definitive treatment (surgical excision, radiation, chemotherapy, or mastectomy) has not yet been executed. It is appropriate for patients seeking a second opinion, for monitoring responses to neoadjuvant chemotherapy, or for patients who require further staging.

The final assessment is always based on the most immediate action required. For instance, a patient with known cancer in one breast may be sent for an outside imaging consultation. In the event that there are no other significant findings apart from the cancer or if there is a benign finding that requires no intervention, the report can be classified as category 6. If another abnormality is found that requires further evaluation, the final assessment would then be category 0. If there is an additional lesion requiring biopsy, then the report would be coded category 4.

In terms of the mammography audit, BI-RADS have helped to more clearly define positive and negative studies. Any screening mammogram coded BI-RADS categories 0, 4, or 5 is considered positive. Categories 1, 2, and 3 are negative. In the scenario of a patient with negative imaging but a clinically significant palpable finding, the report should still be coded based on the imaging findings alone. However, the final assessment should take into consideration the clinical findings and make appropriate recommendations. All breast imaging centers in the USA are required by the Mammography Quality Standards Act (MQSA) to perform a basic medical audit to track sensitivity, specificity, positive and negative predictive values, cancer detection rate, and abnormal interpretation rates. A chapter in the 4 th edition of the ACR BI-RADS manual provides guidance for follow-up and outcome monitoring.
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